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BOYS & GIRLS VILLAGE

Ambulatory Health Care Facilities Clinic/Center Adolescent and Children Mental Health

Provider NPI: 1477583581

Organization Information:
Organization Name:  BOYS & GIRLS VILLAGE
Authorized Official:  L. KENNETH FELLENBAUM  CEO  203-877-0300

Practice Location:
528 WHEELERS FARMS RD  MILFORD, CT 06461-1847 US
Tel: 203-877-0300  Fax: 203-876-0076

Business Mailing Address:
528 WHEELERS FARMS RD  MILFORD, CT 06461-1847 US
Tel: 203-877-0300  Fax: 203-876-0076

NPI Information:
NPI: 1477583581
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X261QM0855XAmbulatory Health Care Facilities
Clinic/Center
Adolescent and Children Mental Health
CTEDT-10
X261QM0855XAmbulatory Health Care Facilities
Clinic/Center
CTOPCC-38
X261QM0855XAmbulatory Health Care Facilities
Clinic/Center
CTCPA-40
X323P00000XResidential Treatment Facilities
Psychiatric Residential Treatment Facility
CTCCF/TS 17

Other Provider Identifiers:

IssuerNumberStateType
004189173-00CT05




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